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Nurses' strike shakes S. African health care


SOWETO, South Africa -- A wildcat strike by nurses at Baragwanath hospital, the largest in the Southern Hemisphere, has thrown health care and labor relations in the Johannesburg area into turmoil.

The strike, which began Monday, spread to clinics throughout the teeming black township of Soweto and several other hospitals in the area. There were fears that the walkout would continue to spread, bringing to a standstill the nation's state-run system that provides health care to all but the wealthy, mainly white, population.

Thousands of patients have been turned away or taken out of hospitals and clinics.

Officials of the Gauteng provincial government issued a return-to-work ultimatum yesterday, saying that otherwise the nurses could face dismissal.

The decree seemed to have little effect on the 1,600 who walked out of Baragwanath hospital. Hundreds gathered outside the hospital offices yesterday, dancing and singing protest songs, refusing to speak to reporters and refusing a management request to provide a skeleton staff to keep essential services functioning.

The strike has been denounced by virtually every political group in the country as well as by various labor groups. Confusing the issue is the fact that it was called by a little-known organization called the Health Workers Forum, not by the nurses' recognized union, which agreed to a 5 percent pay increase in June.

The strikers are demanding a 25 percent increase for nurses, who make around $4,000 a year. Provincial health authorities reply that they have no money to meet this demand and that it must be taken up on the national level. They have urged the national government's negotiating chamber to reopen talks on nurses' pay.

The Forum was little known until last month when it called a similar walkout in Soweto clinics. During the three days of that walkout, Baragwanath provided health care for the sprawling black township that is home to an estimated 4 million people.

But this time, with both Baragwanath and the clinics affected, the situation has reached crisis proportions.

Yesterday morning, there were just over 1,000 patients in the hospital's 3,500 beds, which average about 2,500 patients a day. All but the seriously ill were discharged.

Only the most extreme emergency cases were admitted, and those cases could only be stabilized and then taken elsewhere. All operating theaters and intensive care units have been shut down, with several seriously ill children transferred to private clinics and adults needing intensive care taken to public hospitals still functioning. Ten patients have died since the strike began, though hospital officials could not say if any deaths were due to a lack of care.

Of Soweto's 13 primary care clinics, which serve close to 10,000 people a day, only three were open. Seven maternity wards were closed, so expectant mothers were sent to Baragwanath where the maternity hospital was barely functioning. One supervisory nurse was reported to have delivered 33 babies Tuesday night. Mothers were sent home six hours after delivery.

In the hospital's pediatric section, only one of the eight wards was functioning, its beds holding the 42 children who had not been discharged. On a normal night, there are 20 to 25 pediatric admissions, but Tuesday night there were only six. Some were stopped at the hospital gates by security guards. Others simply heard of the situation and stayed away.

"You look around here and everything seems under control," said Dr. Simon Strachan, one of the pediatricians coming in on shifts to maintain care for the children remaining. "But we don't know what's happening out there in the community."

"I wish the nurses hadn't walked out," said Dr. Michele Zuckerman, another pediatrician. "But most of my anger is directed at the health authorities. We tell them and tell them about the problems at Baragwanath, but they never do anything until they have a crisis on their hands."

There is much speculation about the motives of those behind the new Health Workers Forum. Some say its origin is an inter-union power struggle; others say that its hidden agenda is political as it tries to embarrass President Nelson Mandela's African National Congress-led government. But all agree that it tapped into a deep well of resentment.

"I think there was a lot of expectation that when the new government came in, there would be a lot of improvements," said Dr. Soumati Natha, director of Soweto's clinics. "But those can't be realized in a day."

One problem is that the nurses, paid by the Gauteng province that includes Johannesburg, labor alongside workers paid by the Johannesburg municipality and who received raises of between 6 and 13 percent as well as a better benefits package. Parity with those workers is part of the strikers' demands.

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